Provider Demographics
NPI:1689731218
Name:J T HO MD INC
Entity Type:Organization
Organization Name:J T HO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-845-7420
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-0370
Mailing Address - Country:US
Mailing Address - Phone:304-845-7420
Mailing Address - Fax:304-845-3243
Practice Address - Street 1:1001 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1407
Practice Address - Country:US
Practice Address - Phone:304-845-7420
Practice Address - Fax:304-845-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075335000Medicaid
WV001714019OtherMOUNTAIN STATE BLUE CROSS
OH0209223Medicaid
WV0083291OtherUMW FUNDS
OH0209223Medicaid
WV112130596Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WV0075335000Medicaid